1.Effects of Sarcopenia on Changes in the Prevalence of Patients with Depressive Mood during Inpatient Geriatric Rehabilitation
Akio SHIMIZU ; Keisuke MAEDA ; Junko UESHIMA ; Yuria ISHIDA ; Tatsuro INOUE ; Kenta MUROTANI ; Ayano NAGANO ; Naoharu MORI ; Tomohisa OHNO ; Ichiro FUJISIMA
Annals of Geriatric Medicine and Research 2024;28(4):469-475
Background:
The effect of sarcopenia on depressive mood during geriatric rehabilitation remains unclear. This study investigated the potential influence of sarcopenia on depressive mood among geriatric patients in a rehabilitation setting.
Methods:
This observational cohort study enrolled 204 patients aged ≥65 years (mean age, 78.8±7.6 years; women, 45.1%) admitted to a rehabilitation unit between April 2020 and July 2021. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment criteria, which include low handgrip strength and muscle mass. Depressive mood was defined as a 15-item Geriatric Depression Scale score of ≥6 points. We applied logistic regression models to examine the influence of sarcopenia on depressive mood at discharge.
Results:
We observed sarcopenia in 58.3% of patients. The logistic regression model showed that sarcopenia negatively influenced depressive mood at discharge (odds ratio=5.460; 95% confidence interval, 2.344–13.415). Of the 68 patients without depressive mood at admission, those with sarcopenia (n=31) had a significantly higher incidence of depressive mood at discharge compared with patients without sarcopenia (n=37) (41.9% vs. 16.2%, p=0.037).
Conclusion
Sarcopenia at admission negatively affected depressive mood at discharge from geriatric rehabilitation. Thus, early and routine assessment of sarcopenia is vital for patients undergoing geriatric rehabilitation.
2.Effects of Sarcopenia on Changes in the Prevalence of Patients with Depressive Mood during Inpatient Geriatric Rehabilitation
Akio SHIMIZU ; Keisuke MAEDA ; Junko UESHIMA ; Yuria ISHIDA ; Tatsuro INOUE ; Kenta MUROTANI ; Ayano NAGANO ; Naoharu MORI ; Tomohisa OHNO ; Ichiro FUJISIMA
Annals of Geriatric Medicine and Research 2024;28(4):469-475
Background:
The effect of sarcopenia on depressive mood during geriatric rehabilitation remains unclear. This study investigated the potential influence of sarcopenia on depressive mood among geriatric patients in a rehabilitation setting.
Methods:
This observational cohort study enrolled 204 patients aged ≥65 years (mean age, 78.8±7.6 years; women, 45.1%) admitted to a rehabilitation unit between April 2020 and July 2021. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment criteria, which include low handgrip strength and muscle mass. Depressive mood was defined as a 15-item Geriatric Depression Scale score of ≥6 points. We applied logistic regression models to examine the influence of sarcopenia on depressive mood at discharge.
Results:
We observed sarcopenia in 58.3% of patients. The logistic regression model showed that sarcopenia negatively influenced depressive mood at discharge (odds ratio=5.460; 95% confidence interval, 2.344–13.415). Of the 68 patients without depressive mood at admission, those with sarcopenia (n=31) had a significantly higher incidence of depressive mood at discharge compared with patients without sarcopenia (n=37) (41.9% vs. 16.2%, p=0.037).
Conclusion
Sarcopenia at admission negatively affected depressive mood at discharge from geriatric rehabilitation. Thus, early and routine assessment of sarcopenia is vital for patients undergoing geriatric rehabilitation.
3.Effects of Sarcopenia on Changes in the Prevalence of Patients with Depressive Mood during Inpatient Geriatric Rehabilitation
Akio SHIMIZU ; Keisuke MAEDA ; Junko UESHIMA ; Yuria ISHIDA ; Tatsuro INOUE ; Kenta MUROTANI ; Ayano NAGANO ; Naoharu MORI ; Tomohisa OHNO ; Ichiro FUJISIMA
Annals of Geriatric Medicine and Research 2024;28(4):469-475
Background:
The effect of sarcopenia on depressive mood during geriatric rehabilitation remains unclear. This study investigated the potential influence of sarcopenia on depressive mood among geriatric patients in a rehabilitation setting.
Methods:
This observational cohort study enrolled 204 patients aged ≥65 years (mean age, 78.8±7.6 years; women, 45.1%) admitted to a rehabilitation unit between April 2020 and July 2021. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment criteria, which include low handgrip strength and muscle mass. Depressive mood was defined as a 15-item Geriatric Depression Scale score of ≥6 points. We applied logistic regression models to examine the influence of sarcopenia on depressive mood at discharge.
Results:
We observed sarcopenia in 58.3% of patients. The logistic regression model showed that sarcopenia negatively influenced depressive mood at discharge (odds ratio=5.460; 95% confidence interval, 2.344–13.415). Of the 68 patients without depressive mood at admission, those with sarcopenia (n=31) had a significantly higher incidence of depressive mood at discharge compared with patients without sarcopenia (n=37) (41.9% vs. 16.2%, p=0.037).
Conclusion
Sarcopenia at admission negatively affected depressive mood at discharge from geriatric rehabilitation. Thus, early and routine assessment of sarcopenia is vital for patients undergoing geriatric rehabilitation.
4.Predicting Mortality Risks Using Body Mass Index and Weight Loss at Admission in Patients with Heart Failure
Yuria ISHIDA ; Keisuke MAEDA ; Kenta MUROTANI ; Akio SHIMIZU ; Junko UESHIMA ; Ayano NAGANO ; Tatsuro INOUE ; Naoharu MORI
Annals of Geriatric Medicine and Research 2024;28(2):171-177
Background:
The association of the combination of body mass index (BMI) and weight change at admission with prognoses in patients with heart failure (HF) is unclear. Therefore, we investigated whether BMI and weight changes at admission affect mortality in patients with HF.
Methods:
This retrospective cohort study lasted 99 months, starting in April 2014, and included 4,862 patients with HF from a Japanese real-world database. Cubic and thin-plate smoothing spline analyses were performed to investigate the association of BMI and weight changes with mortality. The percentage weight change was calculated every 6 months. The study outcome was the presence or absence of death.
Results:
The patients’ mean age was 81.5±9.6 years, and 1,239 (25.5%) patients died. Cubic spline analysis revealed a negative correlation of BMI with mortality hazard ratio (HR) (BMI of 18.5 kg/m2 and 25 kg/m2; HR=1.3 [1.2–1.4] and 0.8 [0.7–0.9], respectively). Cubic spline analysis of weight change showed that weight loss tended to increase the mortality HR (each 6% decrease in weight change rate was associated with a 1.1 times higher mortality risk (95% CI [1.0–1.2]) Thin-plate smoothing spline analysis showed that the odds ratio (OR) negatively correlated with BMI (1-year mortality: BMI of 18.5 kg/m2, 22 kg/m2, and 25 kg/m2; OR at 0% weight change=1.5, 1.0, and 0.7, respectively; 2-year mortality: BMI=18.5 kg/m2, 22 kg/m2, and 25 kg/m2; OR at 0% weight change=1.4, 0.9, and 0.7, respectively).
Conclusion
A low BMI in patients with HF was associated with a higher risk of mortality. Weight loss in patients, regardless of BMI, was associated with a higher OR for mortality.
5.A Case of Luminal B Breast Cancer in Which Preoperative Chemotherapy Was Used Due to Ineffective Preoperative Hormone Therapy
Yasuhiro KURUMIYA ; Tae NIWA ; Sakura ONISHI ; Shingo OYA ; Keisuke MIZUNO ; Ei SEKOGUCHI ; Gen SUGAWARA ; Masaya INOUE ; Takehiro KATO ; Naohiro AKITA ; Takayuki MINAMI ; Kosuke INADA ; Kenji TAKEUCHI ; Akihiro SEKIMOTO ; Akihito OGATA ; Akiko OSADA
Journal of the Japanese Association of Rural Medicine 2022;71(1):63-68
A 66-year-old, postmenopausal woman was referred to our hospital because of abnormal breast cancer screening results. A tumor was found in the upper outer part of the left breast. Biopsy revealed papillotubular carcinoma, ER (Allred score total score [TS] 3 = proportion score [PS] 2 + intensity score [IS] 1), PgR (Allred score TS 3 = PS 2 + IS 1), HER2 (2+), fluorescent in situ hybridization 1.1 (negative), and Ki-67 labeling index 15%. In diagnostic imaging, the tumor size was 35 mm. The diagnosis was T2N0M0 Stage IIA, luminal B-like breast cancer. First, letrozole 2.5 mg/day was administered as preoperative hormone therapy. After 2 months of treatment with letrozole, the tumor size had increased to 44 mm and preoperative hormone therapy was discontinued. She was started on preoperative chemotherapy (4 courses of epirubicin plus cyclophsphamide followed by 4 courses of triweekly docetaxel). The tumor size decreased, becoming undetectable. After these preoperative treatments, nipple-sparing mastectomy, sentinel lymph node biopsy, and breast reconstruction with a primary latissimus dorsi flap were performed. As of 3 years and 6 months after the operation, there has been no recurrence. At first, preoperative hormone therapy is performed for Luminal B-like breast cancer as in this case, if the response is insufficient, preoperative chemotherapy after hormone therapy may be a therapeutic option.
6.A Case of Ruptured Pancreatic Pseudocyst Treated With Emergency Distal Pancreatectomy
Akihito OGATA ; Yasuhiro KURUMIYA ; Keisuke MIZUNO ; Ei SEKOGUCHI ; Gen SUGAWARA ; Masaya INOUE ; Takehiro KATO ; Takayuki MINAMI ; Naohiro AKITA ; Hirotake GONDA ; Akihiro SEKIMOTO ; Hirona TODOROKI ; Takuya OSAWA ; Kenta HAMABE ; Kazuki SAKUMOTO ; Saki ISHIYA
Journal of the Japanese Association of Rural Medicine 2022;70(6):649-654
A 48-year-old woman with a history of recurrent alcoholic pancreatitis was found to have a pancreatic pseudocyst. In November 20XX, she visited the emergency department due to sudden abdominal pain. Contrast-enhanced computed tomography showed a pancreatic pseudocyst with a maximum diameter of 67 mm and ascites. A ruptured pancreatic pseudocyst was suspected and abdominal paracentesis was performed. The amylase level in the ascitic fluid was high (3444 IU/L), leading to a diagnosis of acute generalized peritonitis due to rupture of a pancreatic pseudocyst. Intraoperative findings revealed 500 mL of ascites mixed with pancreatic juice and turbid cyst contents, and distal pancreatectomy was performed. The postoperative course was favorable, and the patient was discharged on hospital day 14. Rupture of pancreatic pseudocyst is rare. In this case, it was promptly diagnosed and successfully treated with emergency surgery.
7.Treatment of Thoracolumbar Spinal Fracture Accompanied by Diffuse Idiopathic Skeletal Hyperostosis Using Transdiscal Screws for Diffuse Idiopathic Skeletal Hyperostosis: Preliminary Results
Hisanori IKUMA ; Shinichiro TAKAO ; Yoichi INOUE ; Tomohiko HIROSE ; Keitaro MATSUKAWA ; Keisuke KAWASAKI
Asian Spine Journal 2021;15(3):340-348
This retrospective case series enrolled 13 patients who underwent posterior fixation with both transdiscal screws for diffuse idiopathic skeletal hyperostosis (TSDs) and pedicle screws (PSs) to treat spinal injury accompanied by diffuse idiopathic skeletal hyperostosis (DISH). To describe the usefulness, feasibility, and biomechanics of TSD. Vertebral bodies accompanied by DISH generally have lower bone mineral density than normal vertebral bodies because of the stress shielding effect. This phenomenon tends to makes screw fixation challenging. To our knowledge, solutions for this issue have not previously been reported. Patients were assessed using the data on surgical time, estimated intraoperative blood loss, mean number of stabilized intervertebral segments, number of screws used, perioperative complications, union rate, and the three-level EuroQol five-dimensional questionnaire (EQ5D-3L) score at the final follow-up. The Hounsfield unit (HU) values of the screw trajectory area, and the actual intraoperative screw insertion torque of TSDs and PSs were also analyzed and compared. The surgical time and estimated intraoperative blood loss were 165.9±45.5 minutes and 71.0±53.4 mL, respectively. The mean number of stabilized intervertebral segments was 4.6±1.0. The number of screws used was 4.9±1.3 for TSDs and 3.0±1.4 for PSs. One death occurred after surgery. The union rate and EQ5D-3L scores were 100% and 0.608±0.128, respectively. The HU value and actual intraoperative screw insertion torque of TSDs were significantly better than those of PSs ( We were able to achieve stable surgical outcomes using the combination of TSDs and PSs. The HU value and actual intraoperative screw insertion torque were significantly higher for TSDs than for PSs. Based on these results, when treating thoracolumbar spinal fractures accompanied by DISH in elderly populations, the TSD could be a stronger anchor than the PS.
8.Three Cases of Successful Conservative Treatment of Ischemic Colitis With Hepatic Portal Venous Gas
Kosuke INADA ; Yasuhiro KURUMIYA ; Keisuke MIZUNO ; Ei SEKOGUCHI ; Gen SUGAWARA ; Masaya INOUE ; Takehiro KATO ; Naohiro AKITA ; Takayuki MINAMI ; Akihiro SEKIMOTO ; Kenji TAKEUCHI ; Akihito OGATA ; Akiko OSADA
Journal of the Japanese Association of Rural Medicine 2021;69(6):612-617
Here, we report 3 cases of conservatively treated ischemic colitis with hepatic portal venous gas. In Case 1, an 84-year-old man visited the emergency department because of fatigue, vomiting, and upper abdominal pain. In Case 2, a 72-year-old man was hospitalized for rehabilitation in another hospital following cervical spine trauma. He had diarrhea and mesogastric pain for 2 days and was transferred to our hospital. In Case 3, an 89-year-old woman visited the emergency department because of upper abdominal pain and vomiting. In all cases, we diagnosed the illness as ischemic colitis with hepatic portal venous gas based on computed tomography findings, and the vital signs of all patients were stable. They were treated conservatively. They were able to resume oral intake and were discharged or transferred to another hospital. Hepatic portal venous gas has been considered a poor prognostic sign of severe diseases such as intestinal necrosis. However, recently, reports of cases treated conservatively have been increasing. Conservative treatment may be selected for ischemic colitis associated with hepatic portal venous gas taking into account the patient’s general condition.
9.Early Physical Therapy Intervention for Frail Patients Isolated with COVID-19
Keisuke INOUE ; Yuma NAKAMURA ; Masaki HAKOMORI ; Kazunori TOYODA ; Tomoyuki OGATA ; Shouichirou ISHIHARA ; Shinichi OGAWA ; Ayako KOUZU ; Masashi TAKAHASHI
Journal of the Japanese Association of Rural Medicine 2021;70(1):53-61
Few reports have described assessment methods or exercise interventions in detail for patients isolated with COVID-19. Here, we report our experience of providing physical therapy to these patients based on motor assessment with consideration of infection control. This study involved 4 patients with COVID-19 who needed physical therapy due to a fall or frailty during isolation. The assessment method used was intended to minimize physical contact, to be easily performed, and to reflect muscle strength and balance. Based on the assessment, we created exercise programs and provided exercise intervention to the patients in cooperation with nurses. One patient was discharged early; the other 3 patients showed improved motor function and activities of daily living as a result of the intervention in the acute ward. However, they needed ongoing rehabilitation in the rehabilitation ward. No physical therapists showed signs of COVID-19 infection. Performing motor assessments and providing exercise intervention to these patients isolated with COVID-19 contributed to motor improvement and enabled us to promptly determine whether they needed ongoing rehabilitation.
10.Treatment of Thoracolumbar Spinal Fracture Accompanied by Diffuse Idiopathic Skeletal Hyperostosis Using Transdiscal Screws for Diffuse Idiopathic Skeletal Hyperostosis: Preliminary Results
Hisanori IKUMA ; Shinichiro TAKAO ; Yoichi INOUE ; Tomohiko HIROSE ; Keitaro MATSUKAWA ; Keisuke KAWASAKI
Asian Spine Journal 2021;15(3):340-348
This retrospective case series enrolled 13 patients who underwent posterior fixation with both transdiscal screws for diffuse idiopathic skeletal hyperostosis (TSDs) and pedicle screws (PSs) to treat spinal injury accompanied by diffuse idiopathic skeletal hyperostosis (DISH). To describe the usefulness, feasibility, and biomechanics of TSD. Vertebral bodies accompanied by DISH generally have lower bone mineral density than normal vertebral bodies because of the stress shielding effect. This phenomenon tends to makes screw fixation challenging. To our knowledge, solutions for this issue have not previously been reported. Patients were assessed using the data on surgical time, estimated intraoperative blood loss, mean number of stabilized intervertebral segments, number of screws used, perioperative complications, union rate, and the three-level EuroQol five-dimensional questionnaire (EQ5D-3L) score at the final follow-up. The Hounsfield unit (HU) values of the screw trajectory area, and the actual intraoperative screw insertion torque of TSDs and PSs were also analyzed and compared. The surgical time and estimated intraoperative blood loss were 165.9±45.5 minutes and 71.0±53.4 mL, respectively. The mean number of stabilized intervertebral segments was 4.6±1.0. The number of screws used was 4.9±1.3 for TSDs and 3.0±1.4 for PSs. One death occurred after surgery. The union rate and EQ5D-3L scores were 100% and 0.608±0.128, respectively. The HU value and actual intraoperative screw insertion torque of TSDs were significantly better than those of PSs ( We were able to achieve stable surgical outcomes using the combination of TSDs and PSs. The HU value and actual intraoperative screw insertion torque were significantly higher for TSDs than for PSs. Based on these results, when treating thoracolumbar spinal fractures accompanied by DISH in elderly populations, the TSD could be a stronger anchor than the PS.


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